Search

BACKGROUND: The objective of this study was to evaluate the impact of engaging in preparatory expansive posing on the performance of anesthesiology trainees during a mock structured oral examination. METHODS: A total of 38 clinical residents at a single institution participated in this prospective randomized controlled study. Participants were stratified by clinical anesthesia year and randomly assigned to 1 of 2 orientation rooms to prepare for the examination. The preparatory expansive posing participants stood for 2 minutes with their hands and arms above their heads and with their feet approximately 1 ft apart. Conversely, the control participants sat quietly in a chair for 2 minutes. All participants then received the same orientation and examination. Faculty evaluation of resident performance, residents’ self-assessment of performance, and anxiety score were collected. RESULTS: There was no evidence to support our primary hypothesis that residents who engaged in preparatory expansive posing for 2 minutes prior to a mock structured oral examination would score higher than their control counterparts (P = .68). There was no evidence to support our secondary hypotheses that preparatory expansive posing increases self-assessment of one’s performance (P = .31) or reduces perceived anxiety during a mock structured oral examination (P = .85). CONCLUSIONS: Preparatory expansive posing did not improve anesthesiology residents’ mock structured oral examination performance or self-assessment of their performance, nor did it reduce their perceived anxiety. Preparatory expansive posing is likely not a useful technique in improving the performance of residents in structured oral examinations.

BACKGROUND: This study’s primary aim was to determine how training programs use simulation-based medical education (SBME), because SBME is linked to superior clinical performance. METHODS: An anonymous 10-question survey was distributed to anesthesiology residency program directors across the United States. The survey aimed to assess where and how SBME takes place, which resources are available, frequency of and barriers to its use, and perceived utility of a dedicated departmental education laboratory. RESULTS: The survey response rate was 30.4% (45/148). SBME typically occurred at shared on-campus laboratories, with residents typically participating in SBME 1 to 4 times per year. Frequently practiced skills included airway management, trauma scenarios, nontechnical skills, and ultrasound techniques (all ≥ 77.8%). Frequently cited logistical barriers to simulation laboratory use included COVID-19 precautions (75.6%), scheduling (57.8%), and lack of trainers (48.9%). Several respondents also acknowledged financial barriers. Most respondents believed a dedicated departmental education laboratory would be a useful or very useful resource (77.8%). CONCLUSION: SBME is a widely incorporated activity but may be impeded by barriers that our survey helped identify. Barriers can be addressed by departmental education laboratories. We discuss how such laboratories increase capabilities to support structured SBME events and how costs can be offset. Other academic departments may also benefit from establishing such laboratories.

BACKGROUND: The objective of this study was to investigate whether previous experiences within an anesthesiology-based Objective Structured Clinical Examination (OSCE) assessing communication and professionalism skills was associated with improved performance in a subsequent anesthesiology-based OSCE scenario. METHODS: This retrospective multi-center study used the performance data of 44 Post Graduate Year 4 clinical anesthesia residents from 3 US anesthesiology residency programs on an OSCE scenario that assessed the residents' effectiveness of discussing anesthesiology-specific treatment options with a high-risk patient. Residents from 2 of the programs had no prior anesthesiology-based OSCE experience. Residents from the third program had previously participated in 4 separate multi-scenario anesthesiology-based OSCE sessions in the 2 years prior to this study. Participating residents completed the same scenario at their respective institutions' simulation center. Ten performances were randomly selected for double rating to assess the interrater reliability of the assessments. Interrater reliability was good for the scenario (intraclass correlation coefficient = 0.66, 95% confidence interval = 0.12–0.90). Performance difference between groups with different OSCE experience status were examined using an independent sample t test, with a Wilcoxon-Mann-Whitney test as a sensitivity analysis. RESULTS: Independent sample t test found prior OSCE experience was significantly associated with higher performance scores (t = 2.53, P = .02). The Wilcoxon-Mann-Whitney test result confirmed this finding (z = 3.28, P = .001). CONCLUSIONS: Findings from this study provide preliminary evidence that anesthesiology-based OSCE experience is associated with improved performance in an OSCE scenario, specifically regarding discussions of treatment options with high-risk patients.

Anesthesiologists are both teachers and learners and alternate between these roles throughout their careers. However, few anesthesiologists have formal training in the methodologies and theories of education. Many anesthesiology educators often teach as they were taught and may not be taking advantage of current evidence in education to guide and optimize the way they teach and learn. This review describes the most up-to-date evidence in education for teaching knowledge, procedural skills, and professionalism. Methods such as active learning, spaced learning, interleaving, retrieval practice, e-learning, experiential learning, and the use of cognitive aids will be described. We made an effort to illustrate the best available evidence supporting educational practices while recognizing the inherent challenges in medical education research. Similar to implementing evidence in clinical practice in an attempt to improve patient outcomes, implementing an evidence-based approach to anesthesiology education may improve learning outcomes. (ANESTHESIOLOGY 2019; 131:908–28)

The Accreditation Council for Graduate Medical Education's Next Accreditation System requires residency programs to semiannually submit composite milestone data on each resident's performance. This report describes and evaluates a new assessment review procedure piloted in our departmental Clinical Competency Committee (CCC) semi-annual meeting in June 2016.A modified Delphi technique was utilized to develop key performance indicators (KPI) linking milestone descriptors to clinical practice. In addition, the CCC identified six specific milestone sub-competencies that would be prescored with objective data prior to the meeting. Each resident was independently placed on the milestones by 3 different CCC faculty members. Milestone placement data of the same cohort of 42 residents (Clinical Anesthesia Years 1-3) were collected to calculate inter-rater reliability of the assessment procedures before and after the implemented changes. A survey was administrated to collect CCC feedback on the new procedure.The procedure assisted in reducing meeting time from 8 to 3.5 hours. Survey of the CCC members revealed positive perception of the procedure. Higher inter-rater reliability of the milestone placement was obtained using the implemented KPIs (Intraclass correlation coefficient [ICC] single measure range: before=.53-.94, after=.74-.98).We found the new assessment procedure beneficial to the efficiency and transparency of the assessment process. Further improvement of the procedure involves refinement of KPIs and additional faculty development on KPIs to allow non-CCC faculty to provide more accurate resident evaluations.

Objective: The Accreditation Council for Graduate Medical Education (ACGME) Milestone Project has created the need for specialty focused, developmentally tiered and competency based evidence-based medicine (EBM) instruction. The University of North Carolina at Chapel Hill Health Sciences Library is extending current staff capacity for face-to-face sessions by creating online module templates that can be adapted to meet the specific needs of more residency programs. Method: Testing the effectiveness, quality and usability of the draft templates is part of the project development plan. The specialty focused EBM face-to-face instruction session of the Clinical Based Year (CBY) anesthesiology residents' Academic Medicine Rotation is the model for the online template. In order to be able to compare the validity of the online modules in comparison with face-to-face sessions, baseline data was gathered from a pre-test/post-test completed by the ten anesthesiology resident participants in the 2015 program. The pre-test/post-test included five knowledge questions and two self-perception questions. After the face-to-face session, the anesthesiology residents were asked to review the online module version of the instruction and answer a brief survey about ease of use and preferred learning mode. Results: Seven of ten residents increased their number of correct answers on the post-test. There were no perfect scores on the pre-test and five perfect scores on the post-test. Three of ten residents indicated a higher self-perceived comfort level for completing a PubMed EBM search. Two of ten residents had an increase level of agreement that their PubMed searching skills are sufficient. Seven of ten residents evaluated the online module and rated it as clearly organized and easy to understand and use. Four would prefer to learn and practice the EBM content in a group session with an instructor, two did not have a preference and one strongly preferred to learn online. Conclusion: Pre-test/post-test data confirmed face-to-face instruction had a positive impact on EBM knowledge and moderately improved self-perceived comfort with EBM searching. This baseline data will be used to compare with residents who only use the online format in the future. Positive feedback on ease of using the online module confirms that the template is functional. A more formal objective evaluation is planned. The variety of learning preferences within this small group indicates that face-to-face instruction is preferred by some, but that online modules will better meet the needs of others and appear to be an adequate way to expand our overall reach.